Article

Early, intensive statin treatment is the standard of care after acute
coronary syndrome (ACS). However, the benefit of this approach to prevent major
adverse cardiovascular events has been demonstrated in only one randomised,
placebo controlled trial. The Myocardial Ischemia Reduction with Aggressive
Cholesterol Lowering (MIRACL) trial demonstrated that atorvastatin 80 mg daily,
compared with placebo, reduced time to first occurrence of death, non-fatal
myocardial infarction, resuscitated cardiac arrest, or hospitalisation for
unstable angina (stroke not included) during the 16 week period following ACS.
However, there were no significant effects on individual components of the
composite endpoint except unstable angina. This led some to question whether
early, intensive statin treatment reduces 'hard' events after ACS. Aim The burden
of coronary heart disease after ACS, and therefore the efficacy of its treatment,
depends not only on the occurrence of one ischaemic event, but rather on
cumulative events experienced by patients. Accordingly,
we conducted a post-hoc
analysis of the MIRACL trial to examine the effect of atorvastatin on first as
well as recurrent (i.e. total) hard cardiovascular events after ACS (death,
myocardial infarction, stroke,
and resuscitated cardiac arrest). Methods and
Results In the 3086 patients who comprised the MIRACL trial, atorvastatin 80 mg
did not reduce time to first hard event compared with placebo (hazard ratio 0.89,
95% confidence interval
0.72-1.10, P = 0.27). However, atorvastatin significantly
reduced total hard events (hazard ratio 0.80, 95% confidence interval 0.66-0.97,
P = 0.03). To prevent one hard event during the 16 weeks following ACS, only 11
patient-years of treatment with atorvastatin were required. Conclusion Early,
intensive treatment with atorvastatin is an efficient intervention to reduce hard
cardiovascular events after ACS.

Langue : ANGLAIS